Credentialing Specialist - Clinical Staff Office

University of Iowa; Iowa City (IA); Hybrid; USD 52,000 - 75,000; Full time

Benefits offered by this job

Benefits package

Job summary

The University of Iowa is seeking a Credentialing Specialist to support hospital privileging and managed care credentialing for UI Health Care and outreach clinics. The role requires strong organization, excellent communication, and the ability to manage multiple tasks while ensuring accuracy in credentialing data and compliance with accrediting standards.

Located at the Healthcare Support Services Building in Coralville, IA, the position offers full-time hours with a structured schedule and

Qualifications

• BA or BS degree (or combination of related education and experience) required.
• 1-3 years in a regulatory environment required.
• Proficiency in Microsoft Office Suite (Outlook, Word, Excel) required.
• Excellent written and oral communication skills required.
• Ability to manage multiple tasks and meet deadlines.

Responsibilities

• Examine, verify and document data for completeness and accuracy according to guidelines.
• Prepare privileging packets for committee submission and follow up on verifications.
• Enter and analyze data in a complex credentialing database.
• Support daily credentialing operations and respond to inquiries with sound judgment.
• Maintain knowledge of bylaws and credentialing policies and translate to action.

Skills

Regulatory environment

Written & verbal communication

Multitasking

Education

BA or BS degree

Tools

Microsoft Office

Job description

Job Description

Under general supervision, the Credentialing Specialist performs hospital privileging, managed care credentialing and verification activities by examining and evaluating data according to established guidelines, requiring a knowledge of rules, criterion and accreditation standards and UI Health Care Bylaws, Rules & Regulations. These duties impact the provision of patient care by practitioners at UI Health Care, as well as outreach clinics, external clients and managed care payors.

Under general supervision, the Credentialing Specialist performs hospital privileging, managed care credentialing and verification activities by examining and evaluating data according to established guidelines, requiring a knowledge of rules, criterion and accreditation standards and UI Health Care Bylaws, Rules & Regulations. These duties impact the provision of patient care by practitioners at UI Health Care, as well as outreach clinics, external clients and managed care payors. The Clinical Staff Office (CSO) provides Credentialing Verification Organization services for UI Health Care, Stead Family Children’s Hospital, and numerous UI Health Care Outreach clinics, external clients, managed care payers, State agencies, Colleges, and Student Health Centers (both in-state and out-of-state). This includes obtaining and authenticating sensitive information and interpreting numerous sets of accrediting bodies’ standards and UI Health Care Bylaws, Rules & Regulations. Direct patient care practitioners are delineated privileges by the UI Health Care Clinical Systems Committee, and are not able to see, touch, or bill for patient services until these credentialing and verification processes have been completed in full. The successful candidate must be highly organized, have strong communication skills, a high level of technical computer expertise, excellent customer service skills, be a team player and be willing to go the extra mile to assure all functions are completed in timely and professional manner. Must be able to manage multiple priorities and have strong problem-solving and critical decision-making skills.

Characteristic Duties and Responsibilities

• Examines, evaluates and verifies documents such as reports, applications, records, checks and vouchers, etc. for completeness and accuracy, determining conformity to established guidelines and policies. Follows up on discrepancies and resolves problems. Maintains appropriate files.
• Investigates and analyzes data for accuracy while adhering to compliance standards of accrediting and regulatory bodies (i.e., Joint Commission, NCQA, URAC); prepares privileging packets for supervisors to review for committee submission; tracks and analyzes credentialing applications and materials with clinical department HR Representatives; identifies and follows-up on primary source verifications and pursues contact information for primary source verification.
• Enters data in a complex database that requires specialized subject matter knowledge. Analyzes the data to maintain the database and generate reports.
• Supports daily credentialing operations of the office and clinical departments, including coordination of processes among colleagues, responding to routine and complex inquiries requiring judgement in the application of policies and procedures, and resolves issues concerning missing, questionable, or gaps in information to meet desired deadlines.
• Maintains working knowledge of UI Health Care Bylaws, UI Health Care credentialing policies and procedures, and CSO policies and procedures; translates knowledge into action regarding credentialing and privileging activities at the individual provider level.
• Initiates and processes standardized forms related to area of assignment.
• Conducts interim/ongoing monitoring of practitioner licenses, controlled substance certificates, insurance certificates, board certifications, CPR and other state/federal agencies on a weekly basis.
• Participates in weekly meetings with supervisors to review files and workload; work with supervisors to resolve any issues with files.
• Participates in monthly Quality Improvement meetings for continued development of process improvement as well as policy development and revision of current policies and practices; suggests improvements as issues arise.
• Prepares and educates department contacts on a regular basis about JC standards, NCQA standards and UI Health Care policies and procedures related to credentialing and privileging practices within the department and coordinated with CSO activities.
• Works to support the Clinical Staff Office leadership, including the Chief Medical Officer, the CSO Director, and the Credentialing Supervisors.
• Performs other duties as assigned.

Percent of Time: 100% (full-time)

Work schedule: Some flexibility between the hours of 7:00 AM and 5:00 PM, Monday through Friday

Work location: This position is located at the Healthcare Support Services Building (HSSB), 3231 Ridgeway Drive, Coralville, IA 52241.

Salary level 3A. Starting salary will be determined based on applicant’s qualifications and related/relevant experience. To view the full pay range for salary level 3A: Professional and Scientific Pay Structures | University Human Resources - The University of Iowa.

Benefits Highlights: Fringe benefit package including paid vacation; sick leave; health, dental, life and disability insurance options; and generous employer contributions into retirement plans. Complete information regarding the full benefits package may be viewed at: https://hr.uiowa.edu/benefits.

Qualifications – External

Required Qualifications

• BA or BS degree, or combination of related education and experience is required.
• 1-3 years’ experience in a regulatory environment requiring attention to detail is required.
• Demonstrated proficiency in Microsoft Office Suite (including Outlook, Word, and Excel) is required.
• Demonstrated excellence in written and oral communication skills is required.
• Experience and successful record in managing multiple tasks, meeting deadlines and completing tasks in full is required.

Desired Qualifications

• Working knowledge of medical terminology is desired.
• Knowledge of UI Health Care Bylaws, Rules & Regulations is desired.
• Knowledge of Joint Commission (JC) and National Committee for Quality Assurance (NCQA) standards is desired.

Additional Information

• Classification Title: Support Services Specialist
• Appointment Type: Professional and Scientific
• Schedule: Full-time
• Work Modality Options: Hybrid within Iowa

Compensation

• Pay Level: 3

Contact Information

• Organization: Healthcare
• Contact Name: Jessica Lanham
• Contact Email: [e-mail]